Flip No. 22

Use a checklist to avoid mistakes

Atul Gawande’s Project Check helps health care teams navigate complex and unpredictable situations.

By Flip the Clinic

In 2009, the surgeon, writer, and public health researcher Atul Gawande wrote that, despite our rapidly increasing knowledge, “Avoidable failures are common and persistent. And the reason is increasingly evident:

…the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.

We need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies.” The quote comes from Gawande’s book, The Checklist Manifesto: How to Get Things Right.

In it he argues that, when implemented correctly, a checklist can guide health care teams through extremely complex and unpredictable situations as it has in other high-risk industries like aviation and nuclear power.

Gawande has since helped develop a series of checklists that range from improving patient care during the 12 most common operating room crises to a list of essential maternal and prenatal care practices. (You can find other checklists at Gawande’s Project Check.) Realizing that organizations would find immense value in building their own checklists to improve patient care, Gawande spearheaded the creation of a “Checklist for Checklists”—basically a set of best practices for checklist creation and validation. To access the Checklists for Checklists click here.

Case Study

In a study published in the New England Journal of Medicine, Gawande and a team of researchers simulated 106 surgical crisis scenarios, which ranged from air embolism to malignant hyperthermia to unstable tachycardia. Seventeen different operating teams participated in the study. Each team was randomly assigned to tackle half their crises with checklists and the other half by relying on memory alone. The study found that failures in management were reduced by nearly 75 percent when checklists were used. Of the people participating, 97 percent agreed that they would want checklists used in an intraoperative crisis if they were the patient on the table.


  • Gillian

    I strongly believe in checklists, and as the case study showed, it is evident that they do indeed cut back on mistakes. I think there are many opportunities for improvement on the floor of which I work. We are a medical-surgical telemetry floor that takes on various disease processes, and I think as a new nurse, they would benefit from utilization of these checklists for major events that can happen to our variety of patients. I would like to try this at my workplace!

  • hawaiimarfo

    It’s hard to argue with the success of checklists, because I know that within my own busy, phrenic life, I couldn’t function without lists to remind me of everything I need to get done! Checklists help take the guesswork out of managing complex situations by giving step-by-step instructions for a variety of circumstances that might occur within a particular medical setting. Checklists eliminate the need for people to rely on memory alone, which can fail during urgent, stressful circumstances. The success rate of 75 percent reduction in event failures is pretty remarkable. I think checklists could be widely implemented in a variety of healthcare settings.

  • Carrie Beck Harnish

    I’d be interested if there are any checklists for primary care.

  • Debbie dupree

    What are great idea, I work on a psych unit where patients aren’t always in the right state of mind. A check list would help the nurses be more detailed and help eliminate mistake with a step by step checklist .